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CASE SNIPPET
Year : 2022  |  Volume : 68  |  Issue : 1  |  Page : 58-59

Chondroid metaplasia of peritoneum in absence of prior surgery - A rare presentation with a short review of literature


Department of Pathology, HBT Medical College and Dr R N Cooper Hospital, Juhu, Mumbai, Maharashtra, India

Date of Submission05-May-2021
Date of Decision21-Jun-2021
Date of Acceptance09-Sep-2021
Date of Web Publication21-Jan-2022

Correspondence Address:
M S Khare
Department of Pathology, HBT Medical College and Dr R N Cooper Hospital, Juhu, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.jpgm_391_21

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How to cite this article:
Khatib Y, Gupte P, Talpade Y, Khare M S. Chondroid metaplasia of peritoneum in absence of prior surgery - A rare presentation with a short review of literature. J Postgrad Med 2022;68:58-9

How to cite this URL:
Khatib Y, Gupte P, Talpade Y, Khare M S. Chondroid metaplasia of peritoneum in absence of prior surgery - A rare presentation with a short review of literature. J Postgrad Med [serial online] 2022 [cited 2022 Oct 4];68:58-9. Available from: https://www.jpgmonline.com/text.asp?2022/68/1/58/336286




The presence of chondroid metaplasia in the peritoneum is rare. All cases reported, except one, had a history of prior abdominal surgery.[1],[2],[3],[4],[5] We report the second case of chondroid metaplasia of the peritoneum in a patient with no history of prior surgery. A 35-year-old primigravida underwent LSCS for non-progression of labor. At surgery, an irregular white nodule was incidentally found in the omentum and was excised. Grossly, an omental mass was received measuring 4 cm × 3.5 cm × 2 cm composed of fat along with a shell-shaped glistening white nodule measuring 2.5 cm × 2 cm × 2 cm [Figure 1]a. On cut-section, it was translucent and gritty to cut [Figure 1]b. On microscopy, multiple nodules of mature hyaline cartilage undergoing calcification and endochondral ossification were seen surrounded by fibro-fatty tissue and covered by benign mesothelial cells [Figure 1c, d, e]. There was no evidence of inflammation, atypia, or mitosis. A diagnosis of chondroid metaplasia was made based on the histopathological findings.
Figure 1: a) shell-shaped irregular white peritoneal chondroid nodule surrounded by omental fat; b) cut-section shows smooth, glistening, translucent appearance; c) multiple nodules of mature hyaline cartilage; d) hyaline cartilage (*) surrounded by adipose tissue and mesothelial cells (arrow and inset); e) nodules of hyaline cartilage undergoing calcification and endochondral ossification

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Chondroid metaplasia of the peritoneum is described as the presence of nodules of mature cartilage without atypia and in the absence of malignant mesothelial neoplasm, metastatic adenocarcinoma, or fetal implantation.[4]

Eight cases of chondroid metaplasia of the peritoneum have been reported [Table 1]. Five out of eight cases had prior abdominal surgery. In two cases, history was not available. Seven out of eight cases have been reported in females. Only one case has been reported in a male and it was not associated with prior surgery. These cases presented as single or multiple nodules with the involvement of the peritoneum at different sites. All cases were incidental findings on surgery with size ranging from 2 mm to 2 cm in diameter. Grossly, all cases presented as glistening white nodules composed of lobules of mature hyaline cartilage lined by the mesothelium and some showing foci of calcification or ossification.[2],[3]
Table 1: Review of cases of chondroid metaplasia of the peritoneum reported in English literature

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The pathogenesis of chondroid metaplasia is uncertain and several theories have been proposed. It may be due to the metaplasia of pluripotent sub-mesenchymal cells in response to injury.[2] This was supported by the fact that most cases of chondroid metaplasia have prior history of surgery. Moreover, cases of osseous, squamous, and Mullerian metaplasia of peritoneum have been reported, which indicated that mesothelial cells have the potential to differentiate into heterologous elements, further giving credence to this hypothesis.[3] Franceschi et al.[4] performed the DNA analysis of two cases of chondroid metaplasia and compared them with that of normal peritoneal tissue and tissue extracted from ovarian teratoma. Both cases and normal tissue showed heterozygosity at each informative microsatellite focus, whereas ovarian teratoma was homozygous at many polymorphic microsatellite loci. These results indicate that peritoneal chondroid nodules arise from pluripotent mesodermal stem cells. On genotypic analysis, the cartilaginous tissue had the same allele as normal tissue and no paternal material was detected, ruling out organized products of conception as the cause of chondroid metaplasia. Hence, the theory of whether chondroid metaplasia represented a mature teratomatous proliferation of fetal rests from conception products seems unlikely. Houang et al.[3] suggested that nodules of chondroid metaplasia could represent chondroma arising from the sub-mesothelial mesenchymal tissue. In the present case, with the absence of prior surgery, this possibility cannot be ruled out.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 :: References Top

1.
Roth E, Taylor HB. Heterotopic cartilage in the uterus. Obstet Gynecol 1966;27:838-44.  Back to cited text no. 1
    
2.
Fadare O, Bifulco C, Carter D, Parkash V. Cartilaginous differentiation in peritoneal tissues: A report of two cases and a review of the literature. Mod Pathol 2002;15:777-80.  Back to cited text no. 2
    
3.
Houang M, Merkur H, Russell P. Chondroid metaplasia of the peritoneum. Pathology 2010;42:585-7.  Back to cited text no. 3
    
4.
Franceschi T, Allias F, Mauduit C, Bolze PA, Devouassoux-Shisheboran M. Chondroid nodule in the female peritoneum arises from normal tissue and not from teratoma or conception product. Virchows Arch 2018;473:115-9.   Back to cited text no. 4
    
5.
Nwanze J, Trivedi D, Crawford B, Nakanishi Y. Cartilaginous differentiation/chondroid metaplasia in the peritoneum not associated with prior surgery: A case report and review of the literature. Am J Clin Pathol 2018;150(Suppl 1):S43.  Back to cited text no. 5
    


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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
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